Medical Mutual Insurance

If you are someone that has Medical Mutal Insrance I would love to hear about your experience with getting approval. Thank You, Vicki

Hi Vickie - I too have MM. We are just about to submit for precertification, just waiting for one more report. I am holding my breath! There are some great people on this websight that have shared info with me so I am crossing my fingers that I have everything together. I have heard both positive and negatives about MM. The one thing that I have noticed is that it seems there has been an increase in approvals lately. If you have any specific questions I would be happy to answer, if I can, and I will be happy to share my experience once I go through the process. Good Luck! Stacey

Hey Stacy, Thanks for posting, I haven't even submitted to MM yet and would like to hear about how you had records of all of your weight loss attempts and everything they ask for. I hear they are very strict on the weight loss attempts. I have lost so much weight and gained it back but alot of it was on my own and I have had to changed doctors so many times over the years that it will be hard to dig everything up. I have to beleive if this is meant to be it will happen, and keep telling myself that because I forget it all the time. LOL Good Luck to you and keep me posted. Thanks Vicki

ok here goes... I have medical mutual insurance. I also have no less than 4 co morbidities. severe diabetes to top it out. My policy states that g bypass is coevered if found medically necessary. My submission for approval was originally denied, according to them because i needed more non surgical weight loss attempts, even though i had two years of nutrional appointments with my nutrionist to learn proper eating because of my diabetes. I then began seeing my DR. monthly for at least 4-6 months, to get my weight charted and to get on a supervised diet. After around 4 months the surgeons office resubmitted for an appeal to try and get approval. Finally i was approved. I later found out that my appeal was also going to be denied, however my pcp got into a verball shouting match with MM and for some reason they approved me. Thank god. I am the only patient that my PCP has ever recommended for this surgery. This whole process took almost a year, but getting them to pay was well worth it. My point is to let you know that you can get MM to pay they just make you jump thru hoops for a while. good luck and email me if you need more help or details. hugs. BTW i am down 75lbs since surgery in Jan.

Vicki, I have been approved by MM and am having surgery on June 1st! I would strongly advise to not only find out what MM requires but also what our employer requires as well. My DH works for Ford and they require that it be medically necessary...that is it! MM requires a 6 month supervised weight loss attempt. I would say preferrably with your PCP. Make sure that it is documented! I would go every 2-4 weeks for weigh ins.......once again make sure they write down what you are doing...ie..low fat, low sugar, low calorie, meds...etc.....whatever they have you do. Also if you are seeing another doctor besides your PCP ask them to write a letter for you. The doctor that scoped my knee wrote a very compelling letter on my behalf and I am sure that that helped! MM requires a psych eval. and a 5 year weight history! I did not have a 5 year weight history. I am one that only goes to the doctor when I am sick (who wants to get weighed?) so I did have 5 years of weights but not in a row. The only way I could document my weight was through pictures. I was holding my granddaughter in most of them so it kind of documented the years....I also told them that I would be happy to give them a copy of her birth certificate as proof....they didn't ask for it though! So.....my original package was sent in to MM on January 12.....I called everyday (after about 2 weeks) wrote every thing down....who I talked to...the time of day...and what they told me. On Jan. 22 they said that I was denied because I did not have the 5 year weight history or 6 month supervised diet. I did have the diet part but he did not document it very well. That is when I found the pictures and wrote a letter of appeal sent them to Nicole (at University Hospital) she then submitted them to MM. I called on Feb. 22 and they said that they received the letter but the faxed pictures were to dark to see. They also told me that I was never denied! So Nicole sent the picutres to MM......I checked back the next week and they didn't get them....so I went and had more made....sent them certified mail so I could make sure that they signed for them! Once they received them they wanted a photo ID of me so sent that in certified mail.....after that it took them 5 days to approve me! So...from start to finish.....Jan. 12 to approval on March 31st! Sorry that this is so long but maybe it will help you! If you need anything at all please email me! I kept a lot of notes! Sue

I had my surgery done two and a half years ago and they were less disagreeable back then. I had to provide five years of diet attempts but they took my word for it along with my check in weights with the doctors records. It took about 30 days for the approval and then seeing the psychologist once and four weeks of seeing a dietitian, it took longer to see the surgeon and get the surgery date. I also got approval for a panniculectomy and breast reduction that was done on March first of this year. I saw the Dr. Oct.3 and had to submit pictures twice but was approved on the first request. I have been very blessed. Good luck all and God Bless, Darla

My reply would be too long to answer on MB, but I have documented most things in my profile. You are welcome to read it and e-mail any specific questions I might help you with. Jaimee